Scoping review: Exploring the relationship between chrononutrition and glycemic responses in the adult population.

Chrononutrition, an emerging body of evidence on the relationship between biological rhythms and metabolism, has been established to be associated with glycemic responses. However, the available evidence is inconsistent, due to protocol variations. Therefore, this review aims to summarize the findings on chrononutrition characteristics and their association with glycemic responses among adults. Systematic searches were conducted across six databases (PubMed, EBSCO Host, ProQuest Central, MEDLINE & Ovid, Scopus and Web of Science) to identify all relevant studies published from January 2012. Two reviewers independently screened the abstracts and full-text articles based on the inclusion and exclusion criteria. Details about population characteristics, study methods and key findings were extracted following the PRISMA-ScR guideline. The quality of selected studies was evaluated using the mixed methods appraisal tool. The searchers identified 49 studies eligible for analysis. The results showed that meal timing, particularly night-time eating and snacking were associated with glycemic responses. Regarding meal regularity, skipping breakfast may affect glycemic responses, but no clear conclusion was drawn about its effect on insulin. The association between meal frequency and glycemic responses was inconclusive. Night fasting duration and restricted eating window are potentially associated with glycemic responses. The current review extensively investigates the association between chrononutrition factors and glycemic responses in adults. However, more prospective cohort and interventional studies are needed to better understand this causal-effect relationship.

Kajian Rintis Penilaian Literasi Digital: Kesediaan Guru Prasekolah Menggunakan Platform Pembelajaran dalam Talian untuk Pendidikan Pemakanan (A Pilot Study Assessing Digital Literacy: Preschool Teachers’ Readiness to Use Online Learning Platforms in Nutrition Education) / Jurnal Sains Kesihatan Malaysia

@#eToyBox is a learning management system for preschool teachers to improve their health literacy, which ultimately aims to improve children’s obesity-related behaviour. As part of the development process of eToyBox, assessment on digital literacy, acceptance of digitization of education materials, and perceived barriers in adopting online learning is needed. Fifty-four preschool teachers under the Community Development Department (KEMAS) in Kuala Lumpur, Selangor, and Sarawak, who participated in ToyBox Study Malaysia intervention in 2018, took part in this cross-sectional study. An online self-administered questionnaire was used to assess sociodemographic background, use of communication tools and media, and teacher’s views on adapting the ToyBox modules to digital education materials. Respondents were contacted, and questionnaire link was shared through WhatsApp messages. Most participants (74.0%) were Malay females aged 31 to 40 years old. Most participants had internet access (94.4%) and owned at least a smart phone, laptop or tablet (94.4%). Participants perceived their computer skills to be average (75.0%). Majority of respondents (65.0%) reported advanced and higher abilities in word processing and email, but only 22.0% in spreadsheet skills. The main barrier to accessing online material was unstable internet connection (74.1%). Most respondents (90.0%) agree that adapting effective modules to online learning will be beneficial for professional development and teaching practices. In conclusion, most participants supported digitizing Toybox Study Malaysia educational content and were comfortable 72 with its implementation via an online learning platform. The findings from this study can advise future development of online learning materials for preschool teachers in Malaysia.

Triple burden of malnutrition among Malaysian children aged 6 months to 12 years: Current findings from SEANUTS II Malaysia.

OBJECTIVE: This paper aims to report South East Asian Nutrition Surveys (SEANUTS) II Malaysia data on nutritional status, dietary intake, and nutritional biomarkers of children aged 6 months to 12 years. DESIGN: Cross-sectional survey conducted in 2019-2020. SETTING: Multistage cluster sampling conducted in Central, Northern, Southern, and East Coast regions of Peninsular Malaysia. PARTICIPANTS: 2989 children aged 0.5-12.9 years. RESULTS: Prevalences of stunting, thinness, overweight, and obesity among children aged 0.5-12.9 years were 8.9%, 6.7%, 9.2%, and 8.8%, respectively. Among children below 5 years old, 11.4% were underweight, 13.8% had stunting, and 6.2% wasting. Data on nutritional biomarkers showed a small proportion of children aged 4-12 years had iron (2.9%) and vitamin A deficiencies (3.1%). Prevalence of anaemia was distinctly different between children below 4 years old (40.3%) and those aged 4 years and above (3.0%). One-fourth of children (25.1%) had vitamin D insufficiency, which was twice as prevalent in girls (35.2% vs. boys: 15.6%). The majority of children did not meet the recommended dietary intake for calcium (79.4%) and vitamin D (94.8%). CONCLUSIONS: Data from SEANUTS II Malaysia confirmed that triple burden of malnutrition co-exists among children in Peninsular Malaysia, with higher prevalence of overnutrition than undernutrition. Anaemia is highly prevalent among children below 4 years old, while vitamin D insufficiency is more prevalent among girls. Low intakes of dietary calcium and vitamin D are also of concern. These findings provide policymakers with useful and evidence-based data to formulate strategies that address the nutritional issues of Malaysian children.

From ToyBox Study to eToyBox: Advancing Childhood Obesity Reduction in Malaysian Kindergartens.

Prevention and treatment of childhood obesity is a global concern, and in Malaysia, it is considered a national public health priority. Determinants of childhood obesity are multifactorial and include factors that directly and indirectly influence energy balance-related behaviours, including energy intake and energy expenditure. Interventions to address childhood obesity that have multiple components at different levels have been shown to be the most influential. The ToyBox-study is a childhood obesity intervention aimed at preschool-aged children and their families that had been shown to be effective in several European countries and so was chosen for adaption for the Malaysian setting. Materials were translated and adjusted for the Malaysian context and audience and implemented in kindergartens in Peninsular Malaysia and Sarawak. However, during the COVID-19 pandemic and lockdown, teaching transitioned to being online. This brought an opportunity to reach a wider audience and consider the long-term sustainability of the intervention, and thus eToybox was born. eToybox aims to bring support for healthy energy balance behaviours directly to the teachers, into kindergartens and homes, to encourage families to be active and eat healthily, and prevent or reduce obesity. Through online innovation, the Toybox Study Malaysia programme has been expanded to enhance its potential to impact the promotion of healthy lifestyles among preschoolers and their families, highlighting the importance of a holistic approach to preventing and treating childhood obesity in Malaysia.

Effectiveness of Social Media Interventions to Improve Nutrition Behaviour among Adolescents in Asia: A Systematic Review

@#Aims: The purpose of this review is to evaluate the social media intervention’s efficacy, as well as the intervention’s theory, model, and framework. Design: Systematic review. Data sources: Five databases- PubMed, Web of Sciences, Scopus, Science Direct and Google Scholar were searched systematically from June 18 to July 12, 2022. Methods: Predefined keywords of “social media”, “nutrition”, “behaviour” and “adolescents” were used. The inclusion criteria: (1) 10 to 24 years old participants; (2) social media or website as intervention platform; (3) intervention outcomes related to improvement in nutrition behaviour, anthropometric measures, knowledge and awareness; (4) is a randomized controlled trial, non-randomized controlled trial, cluster controlled, cohort, case control or before and after study design; (5) published in 2000 until 2022; (6) written or translated is English; and (7) conducted in Asia. Results: Review eligibility included nine studies. Three research were web- or website-based, while the other six used social media such as Facebook, WhatsApp, and LINE. Post-intervention outcomes showed significant gains, however some studies found no differences between the intervention and control groups. Conclusion: Social media is a widely accepted platform for educating adolescents about nutrition for behaviour change. However, the evidence shows that the interventions are lack of significant improvement between groups and the used of digital or technological-related theory, model and framework. This review demonstrated the progress of healthy behaviours in nutrition and health literacy among adolescents that can be spread through social network and the value of new technological techniques in managing the targeted population.

Development and Validation of FFQ for Assessing SugarSweetened Beverages (SSB) and High-Energy Dense Foods Intake among Malaysian Adolescents

@#Introduction: Increased consumption of sugar-sweetened beverages (SSBs) is strongly associated with weight gain, dental cavities, and a higher risk of chronic diseases among adolescents. However, there is no available FFQ for the Malaysian population individually to evaluate and assess the consumption of SSBs and high-energy dense (HED) foods among adolescents. Method: A 24-hour diet recall with 30 adolescents were performed via Google Meet to identify the most common and frequent types of SSBs and HEDs foods consumed nowadays. The food checklist of SSBs and HED foods from literature review search was also provided to the participants. Experts critically reviewed each food item and provide a score for its relevancy and essentiality. Face validity were conducted among 10 adolescents to validate the developed FFQ. Results: The final FFQ consisted of 63 food items with ten categories. This FFQ showed high content validity for individual items with I-CVI ranging from 0.67 to 1.00 and overall questionnaires with S-CVI/Ave valued at 0.97. The calculation of Kappa statistic showed that this newly developed FFQ has excellent inter-rater reliability at the item level with K > 0.74 for 55 items and K = 0.57 only for 4 items. Most of the items were marked as relevant with a CVR score of 1.00. Conclusion: The findings of this study imply that the newly developed FFQ could be utilised to estimate the intake of SSB and HED foods of Malaysian adolescents.

Models and theories to support health promotion programmes for overweight and obese adults: A scoping review

@#Introduction: The increasing prevalence of overweight and obesity has been alarming. One approach to address this issue is to implement health promotion programmes. Despite the many health promotion and health intervention programmes held, there is a lack of evidence showing the application of theories and models. This scoping review aimed to explore existing literature and synthesise findings based on models and theories used to support health promotion programmes for overweight and obese adults. Methods: This review was guided by the Arksey and O’Malley framework. Online databases, such as Ovid, PubMed, Scopus, and Web of Science, were used to search for relevant articles using suitable keywords, from January 2015 until December 2021. Articles were written in English and Malay, and the study subjects were adults aged 18-59 years old. Two reviewers independently screened the articles, and the extracted information were tabulated after analysis. Results: A total of 13 different theories and models were found in the 27 articles selected. Many studies reported using the Transtheoretical Model, Social Cognitive Theory, and Health Belief Model in health promotion programmes for overweight and obese adults. Most constructs and components focused on changing health-related behaviours starting with the individual, such as self-efficacy and readiness to change. Majority of the articles showed an improvement in health-related behaviours and had great potential for future studies. Conclusion: When conducting health promotion programmes for overweight and obese adults, researchers should consider models and theories with constructs and components to ensure consistent improvement and potentially significant impacts on health-related outcomes.

Calcium and iron intakes of adolescents in Malaysia and their relationships with body mass index (BMI): Findings from the Adolescent Nutrition Survey 2017

@#Introduction: Adolescent health is a priority considering they represent the future generation. Data from the Adolescent Nutrition Survey 2017 were analysed to determine the prevalence of micronutrient inadequacy, particularly calcium and iron, and the relationship with body mass index (BMI) among Malaysian secondary school students. Methods: This cross-sectional study included students aged 13 to 17 years old studying at public and private schools. Twenty-four hours dietary recall via face-to-face interview was conducted by trained nutritionists to obtain data on dietary intake. For nutritional status, BMI-for-age z-score (BAZ) was analysed using WHO Anthroplus software. Results: From 999 respondents, 449 were boys and 550 were girls. Overall findings indicated that both boys and girls had inadequate intakes of calcium and iron in their daily diet. Mean intakes of calcium (695.7±463.2 mg/day) and iron (23.4±21.0 mg/day) were higher among boys aged 16 to 17 years old. Mean intake of iron were higher among the older age groups. Majority of the respondents (boys: 94%; girls: 97%) did not meet the recommended nutrient intake (RNI) for calcium and more than half (boys: 50%; girl: 80%) did not achieve the RNI for iron. Current findings also found significant positive but weak correlations between calcium (r=0.112, p=0.001) and iron (r=0.084, p=0.008) intakes with BMI-for-age. Conclusion: BMI-for-age was related to calcium and iron intakes among secondary school students in Malaysia. Thus, intervention strategies should focus on early screening and nutrition education on food choices of high calcium and high iron contents, including iron supplementation programmes, if needed.

Proximate, mineral and fatty acid compositions of healthy recipes used in Fit, Eat, Active, Training (F.E.A.T) programme

@#Introduction: Many people are seeking knowledge and skills about preparing healthy meals at home. This study aimed to determine the content of nutrients in 60 healthy dishes prepared for the recipe book Mudah, Sihat, Sedap used in the F.E.A.T nutrition intervention programme. The recipe book was developed as an educational material to guide participants in preparing healthy meals at home. Methods: A needs assessment survey was done to identify food preferences for breakfast, lunch and dinner of obese and overweight respondents. Recipes for these foods were then modified to reduce the calorie, fat, and sugar contents, while adding in fibre sources. Proximate analysis was done based on standard methods of AOAC, while total carbohydrate and calorie contents were calculated using the differentiation and Atwater methods, respectively. Mineral content was determined using atomic absorption spectrophotometer, while fatty acids content was analysed by gas chromatography using the FAME method. Results: Proximate analysis results showed that Kobis Goreng had the most calories (305 kcal/100g) (p<0.05) in all categories. Mineral analysis showed that sodium was significantly highest (p<0.05) in Asam Pedas Daging (554 mg/100g). For fatty acid analysis, Masak Lemak Telur Itik had the highest amount of MUFA (45.1%), Masak Lemak Sotong had the highest amount for SFA (71.8%), and Masak Lemak Cili Api Udang had the highest amount of PUFA (33.7%). Conclusion: This study successfully modified original recipes of selected cuisines used in the recipe book, which contained lower calories compared to original recipes. The calorie and nutrient values for each recipe will be included as nutrition composition information in the recipe book.

The Characteristic of Obesity Intervention Studies Among School Children in Malaysia: A Scoping Review Ciri-ciri Kajian Intervensi Obesiti Dalam Kalangan Murid Sekolah di Malaysia:Suatu Tinjauan Penskopan / Jurnal Sains Kesihatan Malaysia

@#Obesity among school children has now reached an alarming level in most developing countries, including Malaysia. Thus, numerous strategies to curb the rising of obesity focusing on school children have been taking place. However, this issue management is complex, and a holistic approach is needed to address it comprehensively. This scoping review aimed to identify the characteristics of obesity interventions conducted among school children in Malaysia as a principal recommendation to develop a comprehensive obesity intervention. Arksey and O'Malley’s framework used to guide the scoping review process. Published articles on intervention studies conducted for school children in Malaysia from 2007 to 2020 retrieved based on keyword using the selected electronic and local databases. The NVivo 12 Plus software used to place findings in the systematic framework matric form and evidence tables. The final results reported in descriptive tables. Eighteen studies only reviewed among 3417 extracted articles. Thirteen aspects of the characteristics of the interventions identified. The influence of environmental intervention (family and school communities) on children lifestyle identified as a research gap. Combined environmental interventions and educational guides with technology application recognised as one of the potential components for future obesity intervention design amongst school children.

International Waist Circumference Percentile Cutoffs for Central Obesity in Children and Adolescents Aged 6 to 18 Years.

CONTEXT: No universal waist circumference (WC) percentile cutoffs used have been proposed for screening central obesity in children and adolescents. OBJECTIVE: To develop international WC percentile cutoffs for children and adolescents with normal weight based on data from 8 countries in different global regions and to examine the relation with cardiovascular risk. DESIGN AND SETTING: We used pooled data on WC in 113,453 children and adolescents (males 50.2%) aged 4 to 20 years from 8 countries in different regions (Bulgaria, China, Iran, Korea, Malaysia, Poland, Seychelles, and Switzerland). We calculated WC percentile cutoffs in samples including or excluding children with obesity, overweight, or underweight. WC percentiles were generated using the general additive model for location, scale, and shape (GAMLSS). We also estimated the predictive power of the WC 90th percentile cutoffs to predict cardiovascular risk using receiver operator characteristics curve analysis based on data from 3 countries that had available data (China, Iran, and Korea). We also examined which WC percentiles linked with WC cutoffs for central obesity in adults (at age of 18 years). MAIN OUTCOME MEASURE: WC measured based on recommendation by the World Health Organization. RESULTS: We validated the performance of the age- and sex-specific 90th percentile WC cutoffs calculated in children and adolescents (6-18 years of age) with normal weight (excluding youth with obesity, overweight, or underweight) by linking the percentile with cardiovascular risk (area under the curve [AUC]: 0.69 for boys; 0.63 for girls). In addition, WC percentile among normal weight children linked relatively well with established WC cutoffs for central obesity in adults (eg, AUC in US adolescents: 0.71 for boys; 0.68 for girls). CONCLUSION: The international WC cutoffs developed in this study could be useful to screen central obesity in children and adolescents aged 6 to 18 years and allow direct comparison of WC distributions between populations and over time.

A qualitative study of motivators and barriers to weight reduction practices among overweight and obese suburban Malay adults

@#Introduction: Designing an effective and comprehensive weight reduction intervention requires an understanding of the motivating factors and barriers to losing weight. This study explored the motivating factors and barriers to weight reduction through the experiences, emotions and ideas shared among suburban overweight and obese Malay adults. Methods: In this qualitative study, 23 overweight or obese Malay adults aged 30-59 years old were divided into three focus group discussion (FGD). The Socio-Ecological Model (SEM), consisting of four levels (intrapersonal, interpersonal, community, and policy) was utilised in this study. Results: The motivating factors were: (1) Intrapersonal level: self-awareness, health concern, self-confidence, and desire to have good physical appearance, (2) Interpersonal level: social support from family and friends, (3) Community level: availability and accessibility of physical activity facilities and health information, and (4) Policy level: healthy lifestyle programme. The barriers were: (1) Intrapersonal level: lack of knowledge about diet, physical limitations, lack of self-control, and emotion/mood, (2) Interpersonal level: spouse and children, career or housework commitment, (3) Community level: lack of neighbourhood safety, and availability and accessibility of outside foods, and (4) Policy level: availability and accessibility of outside foods. Conclusion: Eight factors were identified as motivating factors and barriers for weight reduction practices. Support from family and friends should be considered when developing an effective and comprehensive weight loss programme as it was both a motivating factor as well as a barrier.

Impak Program Fit, Eat, Active, Training (F.E.A.T) Terhadap Status Pemakanan dan Aktiviti Fizikal dalam Kalangan Dewasa Berlebihan Berat Badan (Impact of the Fit, Eat, Active, Training (F.E.A.T) Program on Nutritional Status and Physical Activity among Overweight Adult) / Jurnal Sains Kesihatan Malaysia

@#Behavioural change interventions for weight loss have been found to be effective in the short term, but their long-term effectiveness remains a question. The objective of this study was to evaluate the effectiveness of the 36 weeks F.E.A.T program combining behavioural changes of healthy eating and physical activity. A quasi-experimental study of overweight adults was conducted in Malacca. A total of 53 subjects (mean age 47.4 ± 7.2 years) completed the program in three stages. In the first stage (T1: weeks 1–12), the intervention group (n = 28) participated in the F.E.A.T program activities, while the control group (n = 25) did not receive the intervention. In the second stage (T2: weeks 13-24), the activity was supervised and monitored by the peer support group. Sustainability of activity was measured at the third stage (T3: weeks 25-36). The effectiveness of the program was measured by changes in dietary intake, physical activity score, body weight, body mass index (BMI), waist circumference (WC) and body fat percentage at T0 (pre-intervention), T1, T2 and T3. All parameters showed significant interaction effects (time*group) except for energy intake. The intervention group showed significant decreases from T0 to T3 for energy intake (-14.3%), body weight (-4.3%), BMI (-4.2%), WC (-10.5%) and body fat percentage (-3.6%). While physical activity level increased by 109.6% for the intervention group. There were no significant differences in all of these parameters among the control group. The results show the effectiveness of the F.E.A.T program on dietary status and physical activity changes during the 36-week of intervention period.

Perspectives of Malaysian parents on eating out: A qualitative analysis

@#Introduction: The culture of eating out among Malaysians has substantially increased in recent years due to the urbanisation of the society. Frequent eating out has been linked with reduced quality of diet, reduced intake of micronutrients, and increased weight gain. This study aims to explore specific factors on the perceptions and behaviours related to eating out from the perspective of parents. Methods: A qualitative study was carried out among 27 informants from various ethnicities and locations in Peninsular Malaysia. All sessions were audio-recorded, fully transcribed and analysed using thematic content analysis. Results: The main overarching theme that surfaced from this study was the role of parents in shaping the practice of eating out. Time constraints due to parents’ work commitments, the availability of various food outlets, increase in family bonding time and food preferences were recurring themes revealed by informants as facilitating factors to eating out. Other emerging themes, such as hygiene of food premises and cost of food, posed as barriers to eating out. Conclusion: These findings offered a better understanding on the eating out practices of a family from the parents’ perspective. Information as such could be incorporated in strategies to enhance the promotion of healthy eating and nutrition interventions that aim to inculcate healthy food choices while eating out.

Validity and Reliability of a Food Frequency Questionnaire (FFQ) to Assess Dietary Intake of Preschool Children.

As there are few food frequency questionnaires (FFQ) to assess the dietary intake of preschool children, this study examined the validity and reliability of an FFQ for this purpose. A total of 210 preschoolers aged 4 to 6 years participated in the validation study, while a subsample of 66 participants joined the reliability study. The FFQ is modified from the ToyBox-study and South East Asian Nutrition Surveys (SEANUTS), and comprised 108 food items from 13 food groups. A three-day estimated dietary record (3DR) was used as reference and reliability was assessed through a second administration of the FFQ (FFQ2), four weeks after the first administration (FFQ1). For the validation study, Spearman's correlation coefficients showed moderate to high correlations (p < 0.001) between FFQ and 3DR. Cross-classification of quartile analysis showed moderate agreement between the two methods. As for reliability, Spearman's correlation coefficients showed moderate to high correlations (p < 0.001) between FFQ1 and FFQ2. Cronbach's alpha values (0.708 to 0.824) and intraclass correlation coefficients (0.710 to 0.826) showed good agreement between repeated FFQs. The results suggest that the FFQ has acceptable validity and good reliability. Hence, the FFQ can be used to assess preschool children's food intake.

Development and Validation of a Physical Activity Educational Module for Overweight and Obese Adolescents: CERGAS Programme.

Educational modules can be effective in educating and motivating adolescents to participate in physical activity (PA). This paper describes the development and validation of a PA educational module for use in an obesity intervention programme, CEria Respek Gigih Aktif Sihat (CERGAS). The present study was conducted in three phases: Phase I was composed of needs assessments with four focus group discussions to elicit adolescents' opinions regarding module content and design, Phase II was the development of the PA module, while Phase III was content and face validation. A content validity index (CVI) was used to assess content validity quantitatively, with a CVI of more than 0.79 being considered appropriate. The needs assessments indicated that content of interest to adolescents included: the benefits of exercise; exercise techniques; ways to increase PA and how to stay motivated. Attractive graphic design was determined as a way to draw the adolescents' attention. The module covered five topics: "Let's Be Active"; "Exercise and Fitness"; "Staying Safe during Exercise and Physical Activity"; "Planning for Success" and "How to Overcome Sedentariness and Get Moving". The module was found to have good content validity (mean CVI = 0.85). Expert members made suggestions to improve the module. These suggestions were then accepted, and the module was modified accordingly. We concluded that the module has good content validity and can be used to improve PA knowledge amongst CERGAS participants.

Nutrition labelling: an exploratory study on personal factors that influence the practice of reading nutrition labels among adolescents

@# Introduction: The consumption of processed food is increasing in developing countries. Nutrition labels on food packaging are important for the education of consumers, particularly adolescents, to help them make healthier food choices. However, there is evidence to suggest that adolescents generally do not use nutrition labels. This study aims to explore the personal factors that influence the practice of Malaysian adolescents in reading nutrition labels. Methods: The participants were adolescents, aged 13-16 years, from five public schools in Negeri Sembilan. Five semi-structured focus group discussions (FGDs) were conducted. The participants discussed their personal views, knowledge and perceptions regarding the use of nutrition labels and food selection. Data gathered from the FGDs were coded through thematic analysis using the NVivo software. Results: While the participants were familiar with nutrition labels, their usage was relatively low during food selection due to the lack of interest in nutrition information, past experiences, hunger and cravings, time constraints and the taste of the food. The main reasons for using nutrition labels were health consciousness and their curiosity about specific nutrition information provided on the labels. The majority of participants believed that information provided on the labels was accurate because it was provided by reliable institutions. There was also misperception among some participants, mixing up nutrition labels with list of ingredients and the expiry dates. A few participants were unconvinced by the labels and stated that the labels provided misleading information. Conclusion: Personal factors such as knowledge, misperception, awareness and trust significantly impact how adolescents read nutrition labels.

Juara Sihat™: Study Design Of A School-Based Childhood Obesity Nutrition Education Programme In Kuala Lumpur, Malaysia / Jurnal Sains Kesihatan Malaysia

The global prevalence of overweight and obesity among children has increased rapidly in the recent decades, includingin Malaysia. Thus, development of effective interventions to prevent childhood obesity in Malaysia is urgently needed.This paper describes the study design of a 12-week multi-component, school-based nutrition education programme aimedat managing childhood obesity. The objective of Juara Sihat™ is to determine the effectiveness of a nutrition educationprogramme in improving anthropometric status, knowledge, attitude and practice (KAP) of nutrition, eating habits andphysical activity level among overweight and obese children. This quasi-experimental study involves two primary schoolsin Kuala Lumpur with similar demographic characteristics. Eligibility criteria of research participants are overweightand obese children aged 9 to 11 years. The main components of the Juara Sihat™ intervention are nutrition educationclasses on healthy eating and active lifestyle; physical activity sessions; and active involvements of parents and teachers.The control school does not receive any interventions. The primary outcome is BMI-for-age z-score, while other outcomesinclude waist circumference, body fat percentage, KAP of nutrition score, dietary intake, physical activity level, sedentarybehaviour and biochemical profile. Outcome measures will be assessed at three intervals: baseline, post-intervention 1(3-month follow-up), and post-intervention 2 (6-month follow-up). The Juara Sihat™ programme represents a promisingapproach to examining the effectiveness of a school-based childhood obesity intervention with strong empowerment ofParents’ and Teachers’ Association (PTA). We anticipate that this study may provide insights towards the development ofmore effective strategies in formulating childhood obesity interventions.

Intervention on whole grain with healthy balanced diet to manage childhood obesity (GReat-Child™trial): study protocol for a quasi-experimental trial.

BACKGROUND: The rapid increase in childhood obesity is a serious public health problem, and has led to the development of many interventions. However, no intervention has emphasized whole grains as a strategy to manage childhood obesity. Therefore, this article describes the protocol of a 12-week multi-component, family-based intervention on whole grain, using a healthy balanced diet for managing childhood obesity. METHODS: The GReat-Child trial utilize a quasi-experimental method in which two schools in Kuala Lumpur are assigned to intervention and control groups. The eligibility criteria are overweight/obese children, aged 9 through 11 years, who has no serious co-morbidities. The children who report consuming whole-grain foods in their 3-day diet-recall during the screening will be excluded. The study sample is characterized by anthropometric measurements (weight, height, percentage of body fat and waist circumference), whole grain and nutrient intakes (3-day 24-h diet recalls), and their knowledge, attitudes and practices towards whole grain. The 12-week intervention is comprised of three components addressing behaviour, personal and environmental factors, based on social cognitive theory: (1) individual diet counselling for the parents; (2) six 30-min nutrition education classes and (3) school delivery of whole-grain foods; The control school does not receive any interventions, however, for ethical purposes, a health talk is conducted after the entire GReat-Child Trial is completed. CONCLUSION: The GReat-Child trial represents a novel approach to examining the effectiveness of the intervention of whole grain in a healthy balanced diet on managing childhood obesity. We anticipate that this trial will reveal not only whether whole grain intervention will be effective in managing childhood obesity, but also provide greater insights into the acceptance of whole grain among Malaysian children.

25-hydroxy-vitamin D demography and the risk of vitamin D insufficiency in the South East Asian Nutrition Surveys (SEANUTS).

The South East Asian Nutrition Surveys (SEANUTS) were conducted in 2010/2011 in Indonesia, Malaysia, Thailand and Vietnam in country representative samples totalling 16,744 children aged 0.5 to 12 years. Information on socio-demographic and behavioural variables was collected using questionnaires and anthropometric variables were measured. In a sub-sample of 2016 children, serum 25-hydroxy-vitamin D (25(OH)D) was determined. Data were analysed using SPSS complex sample with weight factors to report population representative data. Children were categorized as deficient (<25 nmol/L), insufficient (<50 nmol/L), inadequate (<75 nmol/L) or desirable (>=75 nmol/L). In Malaysia and Thailand, urban children had lower 25(OH)D than rural children. In all countries, except Vietnam, boys had higher 25(OH)D levels and older children had lower 25(OH)D. Regional differences after correcting for age, sex and area of residence were seen in all countries. In Thailand and Malaysia, 25(OH)D status was associated with religion. The percentage of children with adequate 25(OH)D (>=75 nmol/L) ranged from as low as 5% (Indonesia) to 20% (Vietnam). Vitamin D insufficiency (<50 nmol/L) was noted in 40 to 50% of children in all countries. Logistic regression showed that girls, urban area, region within the country and religion significantly increased the odds for being vitamin D insufficient. The high prevalence of vitamin D insufficiency in the (sub) tropical SEANUTS countries suggests a need for tailored approach to successfully combat this problem. Promoting active outdoor livestyle with safe sunlight exposure along with food-based strategies to improve vitamin D intake can be feasible options.